1029 - Comparative Efficacy Analysis between Adjuvant Pelvic External Beam Radiation Treatment and Vaginal Cuff Brachytherapy for Women with 2009 FIGO Stage II Uterine Carcinoma with Pathologic Negative Lymph Node Evaluation
Presenter(s)
A. R. Bhatnagar1, I. Aref2, S. Ghosh3, J. Huang-Vredevoogd4, A. J. Doemer4, A. Awada2, and M. A. Elshaikh4; 1Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI, 2Henry Ford Health, Detroit, MI, 3Department of Public Health Sciences, Henry Ford Health, Detroit, MI, 4Department of Radiation Oncology, Henry Ford Health, Detroit, MI
Purpose/Objective(s): The optimal adjuvant radiation therapy (RT) modality for women with 2009 FIGO stage II endometrial cancer (EC) remains a subject of debate. We aimed to evaluate the differences in recurrence patterns and survival endpoints for women who received adjuvant pelvic external beam radiation therapy (EBRT) compared to vaginal cuff brachytherapy (VCB) alone after surgical staging with negative pelvic lymph node evaluation.
Materials/Methods: Our uterine cancer database was queried for women with surgically staged stage II EC from 1/1990 to 12/2024. Patients received either adjuvant pelvic EBRT or VCB, but not both. Patients’ demographics, surgical and pathologic variables, chemotherapy (CT) use, and recurrence patterns were analyzed. Predictors of recurrence-free survival (RFS), disease-specific (DSS) and overall survival (OS) using univariate and multivariate analysis (MVA) were studied.
Results: 143 patients were identified with a median age of 65 years and a median follow-up of 60.8 months. 102 patients (71%) patients had endometrioid EC. 92 patients received EBRT, and of those 22 (24%) received EBRT + CT. 41 patients received VCB, and of those 19 (46%) received VCB + CT. Recurrence was diagnosed in 36 patients (25.2%). In the no CT group, 5-year RFS was 88.8% for EBRT compared to 73% for VCB (p=0.035); 5-year DSS was 95.1% vs. 75.1% (p=0.020), and 5-year OS was 74% vs. 75% (p=0.67), respectively. Among patients who received CT, 5-year RFS was 48% vs. 49% (p=0.424), 5-year DSS was 65% vs. 48% (p=0.253), and 5-year OS was 61% vs. 40% (p=0.245), respectively. In no CT group, independent predictors for worse 5-year RFS and DSS on MVA were grade 3 and VCB use, while older age at diagnosis and grade 3 were predictors for worse OS. There was no prognostic significance of RT modality in regard to RFS, DSS and OS. In the no CT group, EBRT had 1 pelvic and 4 distant recurrences, whereas VCB had 1 vaginal + pelvic, 1 paraaortic (PA) and 8 distant recurrences. Among patients getting CT, pelvic EBRT had 2 vaginal, 1 PA, and 7 distant recurrences, whereas VCB had all 10 distant recurrences.
Conclusion: Our data suggests that pelvic EBRT is an independent predictor for better recurrence-free and disease-specific survival in patients with 2009 FIGO stage II uterine cancer who received adjuvant RT alone. For patients who received chemotherapy, there was no statistically significant difference in survival endpoints between those who received EBRT and vaginal cuff brachytherapy. Multi-institutional pooled analyses is needed to validate our results.